title: Distinguishing adrenal cortical carcinomas and adenomas: a study of clinicopathological features and biomarkers.
abstract: OBJECTIVE
  To determine clinicopathological criteria and molecular markers helpful in distinguishing adrenocortical carcinomas (ACCs) from adrenocortical adenomas (ACAs).
  
  
  RESULTS
  We analysed retrospectively the clinical and pathological features of 50 adrenal cortical tumours, and tested the expression of miR483-3p by in-situ hybridization as well as the expression of IGF2 and Smad4 by immunohistochemistry. We found that tumour size, tumour weight, hormonal function and the Weiss system are all high-efficacy criteria for differentiating malignant from benign tumours (P < 0.001). MiR483-3p was overexpressed in 68% (17 of 25) of ACCs compared to 12% (three of 25) of ACAs (P < 0.05). Using a combination of miR483-3p and Smad4 improved diagnostic accuracy. Molecular markers were then tested in an independent set of 15 borderline tumours. We confirmed that the combined use of miR483-3p and Smad4 immunochemistry can complement the Weiss score in the diagnosis of ACC in cases that display borderline histology.
  
  
  CONCLUSIONS
  Tumour size, tumour weight, hormonal function and the Weiss system are useful clinicopathological criteria that can result in accurate diagnosis of most ACCs and ACAs. In challenging cases, miR483-3p and Smad4 expression may help in distinguishing these two entities.
authors.affiliation: Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing, China.
authors.forename: Cuiping
authors.initials: C
authors.lastname: Wang
authors.forename: Yang
authors.initials: Y
authors.lastname: Sun
authors.forename: Huanwen
authors.initials: H
authors.lastname: Wu
authors.forename: Dachun
authors.initials: D
authors.lastname: Zhao
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism*; D018246:Adrenocortical Adenoma / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism*; D018268:Adrenocortical Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism*; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics* / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D008297:Male; D035683:MicroRNAs / Q000235:genetics* / Q000378:metabolism*; D008875:Middle Aged; D011379:Prognosis; D012334:RNA, Neoplasm / Q000235:genetics* / Q000378:metabolism*; D012189:Retrospective Studies; D051901:Smad4 Protein / Q000378:metabolism*; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; C035170:IGF2 protein, human; C548912:MIRN483 microRNA, human; D035683:MicroRNAs; D012334:RNA, Neoplasm; C497796:SMAD4 protein, human; D051901:Smad4 Protein; D007335:Insulin-Like Growth Factor II
keywords: adrenal cortical tumours; clinicopathological features; diagnosis; differentiation; hsa-mir-483-3p; in-situ hybridization